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山东大学学报(医学版) ›› 2014, Vol. 52 ›› Issue (12): 83-88.doi: 10.6040/j.issn.1671-7554.0.2014.435

• 临床医学 • 上一篇    下一篇

肝脏FibroScan测定和功能评分与肝硬化病理分级的相关性

李继业, 王薇, 潘润华, 阿斯楞, 廖彩仙   

  1. 南方医科大学南方医院肝胆外科, 广东 广州 510515
  • 收稿日期:2014-07-03 修回日期:2014-11-24 发布日期:2014-12-10
  • 通讯作者: 廖彩仙。E-mail:liaocx@fimmu.com E-mail:liaocx@fimmu.com
  • 基金资助:
    南方医科大学南方医院与恒丰实业集团有限公司合作科研项目(肝硬化程度的活体定量评估与临床分级研究)

Correlation between liver functional scores, FibroScan measurement and histological subclassification of cirrhosis

LI Jiye, WANG Wei, PAN Runhua, A Sileng, LIAO Caixian   

  1. Department of Hepatobiliary Surgery, Nanfang Hospital of Southern Medical University, Guangzhou 510515, Guangdong, China
  • Received:2014-07-03 Revised:2014-11-24 Published:2014-12-10

摘要: 目的 探讨肝脏FibroScan测定和功能评分与肝硬化病理分级的相关性。方法 回顾60例肝硬化患者的肝脏穿刺活检病理切片及临床资料,运用Laennec分级系统对病理切片进行组织学分级,分析肝脏FibroScan测定值和功能评分与肝硬化病理分级的相关性。结果 病理分级为肝硬化轻度组27例(45%)、中度组21例(35%)、重度组12例(20%)。肝硬化轻、中、重度组的肝脏FibroScan测定值分别为(14.90±5.54)、(25.23±10.11)、(33.99±13.55)kPa,三组间的差异具有统计学意义(P<0.05);肝脏FibroScan测定值用于判断中重度肝硬化和重度肝硬化的ROC曲线下面积分别为0.908、0.865。肝硬化轻、中、重度组的Child-Pugh评分分别为5.61±1.14、6.05±1.21、5.74±0.93,三组间的差异无统计学意义(P>0.05);肝硬化轻、中、重度组的MELD评分分别为5.90±4.22、7.14±5.33、7.03±5.13,三组间的差异无统计学意义(P>0.05)。结论 FibroScan在诊断肝硬化严重程度方面有一定的应用价值;肝硬化程度与肝脏功能评分无显著相关性。

关键词: 肝硬化, 肝脏弹性值, Child-Pugh评分, MELD评分, 病理分级

Abstract: Objective To investigate the relationship between histological subclassification of cirrhosis and liver functional scores as well as FibroScan transient elastography. Methods Clinical data of 60 biopsy-proven cirrhosis cases with different severity were collected and respectively reviewed. The liver functional scores and FibroScan values were assessed. Histology of cirrhosis was blindly subclassified using the Laennec fibrosis scoring system semi-quantitatively. Results Sixty cases were classified into 3 groups: mild cirrhosis group(n=27, 45%), moderate cirrhosis group(n=21, 35%) and severe cirrhosis group(n=12, 20%). FibroScan values of mild, moderate and severe cirrhosis groups were (14.90±5.54), (25.23±10.11) and (33.99±13.55)kPa, respectively, with significant difference among the groups (P<0.05). The areas under the receiver operating characteristic (ROC) curve of FibroScan were 0.908 for moderate to severe cirrhosis, and 0.865 for severe cirrhosis. Child-Pugh scores of the three groups were 5.61±1.14, 6.05±1.21 and 5.74±0.93, respectively, with no significant difference among them (P>0.05). MELD scores of the three groups were 5.90±4.22, 7.14±5.33 and 7.03±5.13, respectively, with no significant difference (P>0.05). Conclusion FibroScan is a valuable examination for liver cirrhosis. There is no correlation between liver functional scores and histological subclassification of cirrhosis.

Key words: Child-Pugh score, Histological subclassification, FibroScan value, Liver cirrhosis, MELD score

中图分类号: 

  • R657.3
[1] 中华医学会传染病与寄生虫病学分会, 肝病学分会. 病毒性肝炎防治方案[J]. 中华肝脏病杂志, 2000, 8(6): 324-329.
[2] Kim S U, Oh H J, Wanless I R, et al. The laennec staging system for histological sub-classification of cirrhosis is useful for stratification of prognosis in patients with liver cirrhosis[J]. J Hepatol, 2012, 57(3): 556-563.
[3] Nagula S, Jain D, Groszmann R J, et al. Histological-hemodynamic correlation in cirrhosis-a histological classification of the severity of cirrhosis[J]. J Hepatol, 2006, 44(1): 111-117.
[4] 董家鸿, 郑树森, 陈孝平, 等. 肝切除术前肝脏储备功能评估的专家共识(2011版)[J]. 中华消化外科杂志, 2011, 10(1): 20-25. DONG Jiahong, ZHENG Shusen, CHEN Xiaoping, et al. Consensus on evaluation of hepatic functional reserve before hepatectomy (2011 edition)[J]. Chin J Dig Surg, 2011, 10(1): 20-25.
[5] 周鸿, 刘晔, 陈炜, 等. MELD评分在肝硬化患者预后评估中作用的临床研究[J]. 肝胆外科杂志, 2010, 18(4): 251-286. ZHOU Hong, LIU Ye, CHEN Wei, et al. The clinical research of MELD score in prognostic evaluation of patients with liver cirrhosis[J]. Journal of Hepatobiliary Surgery, 2010, 18(4): 251-286.
[6] Sandrin L, Fourquet B, Hasquenoph J M, et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis[J]. Ultrasound Med Biol, 2003, 29(12): 1705-1713.
[7] 中华肝脏病学会肝纤维化学组.肝纤维化诊断及疗效评估共识[J]. 中华肝脏病杂志, 2002, 10(5): 8-9. Hepatic Fibrosis Study Group of Chinese Liver Diseases Association. Consensus on evaluation of the diagnosis and efficacy of hepatic fibrosis[J]. Chin J Hepatol, 2002, 10(5): 8-9.
[8] Kim M Y, Cho M Y, Baik S K, et al. Histological subclassification of cirrhosis using the Laennec fibrosis scoring system correlates with clinical stage and grade of portal hypertension[J]. J Hepatol, 2011, 55(5): 1004-1009.
[9] Gallegos-orozco J F, Vargas H E. Liver transplantation: from Child to MELD[J].Med Clin North Am, 2009, 93(4): 931-950.
[10] Kamath P S, Wiesner R H, Malinchoc M, et al. A model to predict survival in patients with end-stage liver disease[J]. Hepatology, 2001, 33(2): 464-470.
[11] Suk K T. Hepatic venous pressure gradient: clinical use in chronic liver disease[J]. Clin Mol Hepatol, 2014, 20(1): 6-14.
[12] 中华医学会消化病学分会, 中华医学会肝病学分会, 中华医学会内镜学分会. 肝硬化门静脉高压食管胃静脉曲张出血的防治共识[J]. 中华肝脏病杂志, 2008, 16(8): 564-570. Chinese Society of Gastroenterology, Chinese Society of Hepatology and Chinese Society of Endoscopy, Chinese Medical Association. Consensus on prevention and treatment for gastroesophageal varices and variceal hemorrhage in liver cirrhosis[J]. Chin J Hepatol, 2008, 16(8): 564-570.
[13] Ripoll C, Groszmann R, Garcia-Tsao G, et al. Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis[J]. Gastroenterology, 2007, 133(2): 481-488.
[14] Kumar M, Sakhuja P, Kumar A, et al. Histological subclassification of cirrhosis based on histological-haemodynamic correlation[J]. Aliment Pharmacol Ther, 2008, 27(9): 771-779.
[15] Castera L, Forns X, Alberti A. Non-invasive evaluation of liver fibrosis using transient elastography[J]. J Hepatol, 2008, 48(5): 835-847.
[16] 肝脏硬度评估小组. 瞬时弹性成像技术诊断肝纤维化专家意见[J]. 中华肝脏病杂志, 2013, 21(6): 420-424. Review Panel for Liver Stiffness Measurement. Recommendations for the clinical application of transient elastography in liver fibrosis assessment[J]. Chin J Hepatol, 2013, 21(6): 420-424.
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